Sleep is one of the most common reasons people reach for cannabis. Federal survey figures cited in a new commentary put past-year use at 15.0% of adults over 50 and 10.5% of those 65 and older, and the Centers for Disease Control and Prevention estimates 61.9 million people in the United States used cannabis in 2022. The products have changed too: the National Institute on Drug Abuse reports that the average THC concentration in cannabis seized by law enforcement quadrupled between 1995 and 2022, from 3.96% to 16.14%.

Two papers published this October approach the same question from opposite directions: does cannabis actually improve sleep, and how much is known about the people using it most? Their answers converge, and the shared conclusion is that the aisle has moved ahead of the evidence.

A 35-year cohort, measured two ways

The larger paper, published 1 October in JAMA Network Open, draws on the CARDIA study, a US cohort of 5,115 Black and white adults recruited in 1985 and 1986 at ages 18 to 30 and examined repeatedly since. At the year-35 visit, held in 2020 to 2022, 891 participants wore a wrist actigraphy device for seven days and 1,128 completed the Pittsburgh Sleep Quality Index, a standard self-report questionnaire. The analysable group had a mean age of 60.7 years and was 63.3% female, 41.0% Black and 59.0% white.

The team, funded by the National Heart, Lung, and Blood Institute, converted lifetime use into “cannabis-years” — one cannabis-year representing 365 days of use — and analysed cumulative exposure alongside use in the past 30 days.

Each additional cannabis-year was associated with higher odds of measured sleep problems: a low sleep percentage, under 85% of time in bed spent asleep (odds ratio 1.10, 95% CI 1.06–1.14); high sleep fragmentation, the top quartile of restlessness (1.04, 1.01–1.08); and prolonged wakefulness after sleep onset, at least 30 minutes awake (1.21, 1.10–1.34). Recent users differed most from people who had never used: their odds of prolonged wakefulness after sleep onset were 3.23 times higher (95% CI 1.44–7.27), and their odds of sleeping longer than eight hours rather than the six-to-eight-hour band treated as optimal were 4.60 times higher (1.81–11.70).

This is cohort evidence, so it describes associations rather than causes. The authors report that the links held after adjustment for lifetime cigarette and alcohol exposure, physical activity, body mass index, depressive symptoms and other substance use.

Where the two measurements stopped agreeing

None of those findings appeared in the self-reported data. Cannabis use showed no association with sleep quality as participants described it.

That divergence is the paper’s most useful contribution, and the authors treat it as a measurement finding rather than a contradiction. Actigraphy captures movement across a single seven-night window; a questionnaire captures how sleep felt. The October commentary describes the same pattern: people sometimes report substantial changes in sleep quality despite modest or absent changes on polysomnography or actigraphy. Our earlier look at sleep regularity research ran into a version of this, where research-grade accelerometer measures do not map onto consumer sleep scores.

The group the research skips

The second paper, a commentary published 9 October in the Journal of Cannabis Research by clinicians at Yale School of Medicine and the VA Connecticut Healthcare System, examines the population doing much of that reaching. Adults over 50 are among the fastest-growing groups of cannabis users, with the steepest rise in those 65 and older, and sleep disturbance is consistently among the most common reasons they report using it. Insomnia affects up to half of older adults.

The complaint is not that cannabis fails for older users but that almost nobody has tested it in them. Most experimental work on cannabinoids and sleep has been done in younger adults, often with formulations that differ substantially from what is sold today; “rigorous studies specifically enrolling older adults are virtually nonexistent,” the authors write.

They set out why older adults are not simply older versions of younger users. Body composition, liver and kidney function shift with age, and the pharmacokinetics of THC, CBD and cannabinol in older adults are poorly characterised. Because this group often takes multiple prescription medicines, interaction risk matters, and CBD in particular is metabolised through cytochrome P450 pathways. Age-related reductions in CB1 receptor availability, the receptor THC acts on, raise the further possibility that responses differ in later life in ways nobody has measured.

Then there is tolerance, which complicates how “it helps me sleep” should be read. Repeated THC exposure produces tolerance and early improvements may fade. Abrupt discontinuation is associated with difficulty falling and staying asleep, and withdrawal-related insomnia is among the most common reasons people resume using — which, the authors suggest, means some reported benefit among chronic users may reflect relief of withdrawal symptoms rather than a durable therapeutic effect. The commentary also points to a placebo-controlled trial of 150 mg of CBD nightly in primary insomnia, which improved objectively measured sleep efficiency modestly but not most subjective measures.

A commentary synthesises other people’s work and argues a position, which places it below trial evidence. The authors disclose funding from the Yale Center for the Science of Cannabis and Cannabinoids and declare no competing interests. Their conclusion in their own words: evidence-based treatments for chronic insomnia should remain the first-line therapy until adequately powered randomised trials exist, and “the absence of evidence should not be interpreted as evidence of either benefit or harm.”

What the federal fact sheets commit to

The National Center for Complementary and Integrative Health describes the sleep evidence as suggestive but confounded. Studies in people with multiple sclerosis, PTSD or chronic pain often found better sleep quality, fewer disturbances or shorter time to fall asleep. But NCCIH says it is uncertain whether the products affected sleep directly or whether people slept better because their other symptoms improved, and the effects in people without another illness remain uncertain. The FDA-approved cannabinoid medicines are for rare epilepsies, chemotherapy-related nausea and vomiting, and appetite and weight loss in HIV, not insomnia.

Safety guidance is more concrete. NCCIH notes that some people who use cannabis develop cannabis use disorder, with symptoms including craving, withdrawal and loss of control, and that adolescents who use cannabis are four to seven times more likely than adults to develop it. Smoking during pregnancy has been linked to lower birth weight. CBD has been associated with decreased alertness, mood changes, digestive symptoms, liver injury, male reproductive harm and drug interactions.

NIDA puts numbers on the dependence question: studies estimate 22% to 30% of people who use cannabis have cannabis use disorder, and about 12.1% of frequent users experience withdrawal, whose symptoms include insomnia. Higher THC concentrations have been linked to a greater likelihood of use progressing to the disorder. No medication is FDA-approved for cannabis use disorder, though behavioural treatments including cognitive behavioural therapy and contingency management have evidence behind them. The CDC adds that cannabis affects brain regions involved in memory, attention, decision-making, coordination and reaction time, impairs driving-related skills, and that smoked cannabis harms lung tissue.

What sits at the front of the queue instead

For chronic insomnia, the settled first-line option is not a supplement-aisle product. MedlinePlus lists lifestyle changes including good sleep habits for short-term insomnia, and cognitive behavioural therapy — which it says helps relieve the anxiety linked to chronic insomnia — alongside medicines that can help re-establish a regular sleep schedule. Chronic insomnia lasts a month or longer, and most cases are secondary: a symptom or side effect of another condition, a medicine, another sleep disorder, or substances including caffeine, tobacco and alcohol. The first question is therefore what is keeping someone awake, not which product to add to an evening routine.

What we did not find

  • No long-term randomised trial of cannabis or cannabinoids for insomnia in older adults. On the commentary’s assessment, such studies are virtually nonexistent, and the trials that do exist are small, short and mostly conducted in younger adults.
  • Nothing establishing sustained benefit from regular use. Tolerance and withdrawal-related sleep disruption complicate any reading of longer-term use.
  • No assurance that a label predicts what is inside a product. Items sold at dispensaries, retail stores and online are not FDA-approved and, the commentary notes, vary widely in cannabinoid composition, potency and formulation.
  • No evidence that popular claims about CBD or cannabinol for sleep rest on more than preliminary, inconsistent findings.

None of this is medical advice, and none of it is an argument that cannabis is worthless. The narrower reading of two October papers and the federal fact sheets is this: in the largest and longest cohort, measured sleep looked worse with more use; the benefit users describe is real to them but is not the same thing as measured sleep; and the group whose use is growing fastest has the thinnest evidence behind it. Anyone weighing cannabis for persistent sleep problems is better served raising it with a healthcare professional, in line with our medical disclaimer. The evening-routine basics in our archive piece on habits to avoid before bed are what the guidance puts ahead of any product.